Coronary risk factor management in the framework of a community hospital-based ambulatory exercise training program

Ischemic heart disease is a chronic illness that causes major mortality and morbidity. Angiographic studies have shown the effectiveness of exercise programs, in combination with aggressive lipid management, in reversing or slowing the progression of atherosclerotic coronary disease. Despite these studies, participation in supervised programs that combine exercise and risk-factor management is limited. The authors measured the ability of a community hospital-based ambulatory cardiac rehabilitation program to recruit patients and to facilitate reduction of risk factors that have been demonstrated to influence progression of disease. Patients were recruited from a single community hospital for an ambulatory exercise training and cardiac risk-factor management program, and clinical and laboratory data was collected periodically. Recruited patients participated in a minimum 3-month period of training and counseling by a multidisciplinary team with follow-up measurements of weight, lipid profile, blood pressure, and exercise capacity. Thirty-two percent of the eligible hospitalized patients were successfully recruited into the program. Dropout rates over the initial 3 months were low (25%). Improvement in low-density lipoprotein cholesterol level (-4.5%), high-density lipoprotein cholesterol level (+7%), body mass index (-2%), systolic blood pressure (-3%), and maximum metabolic equivalents (+25%) were comparable to levels achieved in studies showing angiographic stabilization and/or regression of disease. Implementation of a community hospital-based risk management exercise program is an effective method for improving the long-term management of patients with chronic ischemic heart disease.